Ep. 39 Mood & Stress Management
Episode Summary: Mastering the Psychology and Physiology of Chronic Pain
In this episode of 'It's Not In Your Head Podcast,' Justine Feitelson and Dr. Dan Bates tackle effective strategies to manage mood and stress for chronic pain sufferers. They explore the impact and fundamentals of diaphragmatic breathing techniques, and share ways to integrate mindfulness and movement more effectively into daily life in different situations. This episode aims to equip patients with simple, actionable strategies that impact pain and the common co-existing challenges of anxiety and depression, so they can develop more agency and decrease helplessness.
Episode Overview
The episode addresses chronic pain, its psychological impacts (depression, anxiety, stress), and introduces coping strategies to lessen their impact.
Understanding Normal Responses to Pain
Chronic pain often leads to sadness, anxiety, and fear of movement; these reactions are normal, it’s their affect that must be mitigated.
Be gentle with yourself and recognize that managing mood and stress are essential for living with pain.
For severe cases of anxiety or depression, or factors like PTSD or pronounced catastrophizing, additional professional psychological referral is recommended.
Stress and Allostatic Load
Stress is both as an unavoidable part of life and a contributor to chronic pain.
The concept of “allostatic load” is the cumulative physiological cost of stress, affecting both mental and metabolic health.
Stress responses are divided into primary (nervous and hormone changes) and secondary (measured by markers like blood pressure, glucose, weight) compensation mechanisms.
High allostatic load increases risks of chronic diseases and can amplify pain.
Self-Management Strategies
Breathing Techniques
Breathing is an immediate tool to regulate the nervous system; nose breathing is recommended for multiple physiological benefits.
Signs of dysfunctional breathing or posture (mouth breathing, shallow breaths, prominent rib/neck muscles etc.) are discussed, with practical cues for improvement.
Various positions (lying on back, “crocodile breathing”, band feedback) are introduced to help retrain diaphragmatic and 360-degree breathing.
Breathing also influences digestion, pelvic stability, and core strength, with positive effects on pain and anxiety.
Movement
Movement is essential for both physical and mental health; doing too little (staying on the couch) or too much (marathons) can worsen pain.
Find a “sweet spot”—moving just enough, adjusting to limitations, and pivoting activities as needed and using strategies like the “letterbox program” are key
Injury stories highlight the importance of adaptively exercising parts of the body that are not affected by pain, highlighting the principle of “move it or lose it”.
Mindfulness and Acceptance
Mindfulness is layered onto breathing for greater effect with tools like the BAD (Breathing, Awareness, Distancing) Mindfulness Framework.
Mindfulness exercises like the STOP Meditation Log and “cubby holding” (tracking emotions, bodily sensations, thoughts etc) are used as examples to help develop emotional awareness.
Mindful attention can be incorporated into daily routines (eating, showering, chores) as a way to stay present and disrupt automatic stress responses.
Mindset - Acceptance is emphasized—not as resignation, but as recognition of the current reality combined with a commitment to improvement.
Goal setting, combined with acceptance, enhances self-efficacy and agency and decreases hopelessness.
Breath Training and Progression
Practice transitioning breathing habits from daytime (conscious) to nighttime (unconscious), and from at rest to movement.
Use tempo variations (triangle breathing, square breathing) to deepen relaxation and train CO2 tolerance over time.
Experiment and adapt techniques to your own needs.
Conclusion
Again, sadness, anxiety, and stress are “100% normal” responses to chronic pain.
The episode encourages listeners to “own” their self-management using practical breathing, movement, and mindfulness techniques, and to seek professional help when self-management isn’t enough.